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Embattled Phoenix VA's health-care quality measured

While complaints have piled up about the Phoenix Veterans Affairs hospital's long wait times, there's been less attention paid to the quality of care that the hospital has provided to veterans in metro Phoenix.

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The hospital industry has made a concerted effort to reduce central-line bloodstream infections, also known as sepsis, through evidence-based practices such as handwashing and using sterile catheters and masks.

Several federal, state and private-sector database show measures of health-care cost and quality.

While complaints have piled up about the Phoenix Veterans Affairs hospital's long wait times, there's been less attention paid to the quality of care that the hospital has provided to veterans in metro Phoenix.

Hospitals increasingly are required to report cost and quality measures to federal and state regulatory agencies, which have made such information available to the public through searchable databases.

The Centers for Medicare and Medicaid Services and Arizona Department of Health Services provide detailed health and cost data on individual hospitals. Foundations such as the Commonwealth Fund and the private-sector Leapfrog Group compile health-outcome measures.

These websites measure hospitals' cost, quality or a combination of both, and some experts believe such public reporting is an important tool in forcing providers to be more accountable in both how much they charge and the quality of care they provide.

"It builds transparency into the system," Arizona Department of Health Services' Director Will Humble said of his agency's database, called AZ Hospital Compare.

Arizona's website does not include information on the Phoenix VA system, and the Centers for Medicare and Medicaid's Hospital Compare database has limited information on VA hospitals.

The VA, too, provides the public limited information on quality measures, but the health-care system for veterans maintains an internal database called the Strategic Analytics for Improving and Learning, or SAIL, that ranks the VA's hospitals' performance measures on a five-star system. Under that ranking, the Phoenix site scored a one-star ranking, the system's lowest, according to an internal VA database obtained by the Wall Street Journal.

Jean Schaefer, a spokeswoman for the Phoenix VA, said the SAIL databases measures are reported to other regulatory agencies. Still, the VA considers the database an internal document that is not available to the public.

The Phoenix VA has a central-line bloodstream-infection rate that is about 11 times greater than those found at the federal health-care system's highest-quality hospitals. The Phoenix system had 3.8 infections per 1,000 patients for the year that ended March 31, compared with a rate of 0.32 per 1,000 at the system's top-performing hospitals, according to the VA database obtained by the Wall Street Journal.

Neither Medicare's Hospital Compare nor the Commonwealth Fund's databases reported central-line infection rates for VA facilities. But the Commonwealth Fund's database had detailed infection rates on other similar-sized hospitals in metro Phoenix. No other hospital had an infection rate nearly as high as the reported numbers for the Phoenix VA hospital, according to the Commonwealth Fund's Why Not The Best database.

Maricopa Medical Center, the region's safety-net hospital that handles some of the most acute cases, had a central-line infection rate of 1.23 per 1,000 patients from July 2012 through June 2013. That's the highest among 19 metro Phoenix hospitals with at least 100 beds, according to the Commonwealth Fund's database. Mayo Clinic had the lowest rate, 0.11 infections per 1,000.

Robert Fromm, chief medical officer of Maricopa Medical Center, said the hospital's central-line infection rates are in line with national benchmark rates even though it treats high-risk patients in its burn unit. Fromm said it has adopted practices to reduce the rate.

Central-line infections, known as sepsis or blood poisoning, are among the biggest killers in hospitals. The federal Department of Health and Human Services and the hospital industry have targeted such infections as hospital-acquired conditions that can be prevented through good practices, such as doctors washing their hands and ensuring catheters and masks are sterile.

Peter Pronovost, a physician who pioneered a checklist of evidence-based practices to reduce such infections and death rates in Michigan, said central-line infection rates are a key indicator of a hospital's overall quality.

"It's the canary in the coal mine," said Pronovost, medical director of Johns Hopkins University's Center for Innovation in Quality Patient Care. "If I look at where I may choose care, that is a great measure to say, 'Does that hospital have its act together — or does it not?' "

Pronovost believes public reporting of infection rates has helped pressure the health-care industry and hospital administrators to take steps to ensure infection rates are reduced.

The Commonwealth Fund's database shows the Phoenix VA system was in the middle of the pack among similar-sized Phoenix-area hospitals based on another measure — death rates for patients within 30 days of heart failure, heart attack and pneumonia.

Ken Alltucker covers health care for The Republic. He has written about the Affordable Care Act, consumer health, insurance, prescription drugs and hospitals.